Renal Net Acid Excretion Capacity Is Comparable in Prepubescence, Adolescence, and Young Adulthood but Falls with Aging

Berkemeyer, Shoma; Vormann, Jürgen; Günther, Anke L. B.; Rylander, Ragnar; Frassetto, Lynda; Remer, Thomas

doi:10.1111/j.1532-5415.2008.01799.x

Cited by 45 publications

(25 citation statements)

References 35 publications

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“…This finding suggests that young adults handle even large acid loads within the range of usual dietary intake without perturbing acidbase status. Our data indicate that this capacity already begins to diminish by the fourth decade of life, which is consistent with previous reports (25,30). It should be noted, however, that acid retention may occur even without apparent perturbation of the serum bicarbonate or extracellular pH.…”

Section: Discussionsupporting

confidence: 82%

“…Despite these variations in diet, renal acid excretion maintains acid-base homeostasis in normal persons, but this capacity declines with age (25). Our results extend these findings to indicate that dietary acid plays a role in determining acid-base status on a population-wide level and that this effect is most pronounced among older persons.…”

Section: Discussionsupporting

confidence: 78%

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Dietary Acid, Age, and Serum Bicarbonate Levels among Adults in the United States

Amodu

Abramowitz

2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Greater dietary acid has been associated with lower serum bicarbonate levels in patients with CKD. Whether this association extends to the general population and if it is modified by age are unknown.Design, setting, participants, & measurements This study examined the association of the dietary acid load, estimated by net endogenous acid production, with serum bicarbonate levels in adult participants in the National Health and Nutrition Examination Survey 1999-2004.Results The mean serum bicarbonate was 24.9 mEq/L (SEM=0.1), and the mean estimated net endogenous acid production was 57.4 mEq/d (SEM=0.4). Serum bicarbonate was linearly associated with age, such that the oldest participants had the highest serum bicarbonate levels. After multivariable adjustment, participants in the highest quartile of net endogenous acid production had 0.40 mEq/L (95% confidence interval, 20.55 to 20.26) lower serum bicarbonate and a 33% (95% confidence interval, 3 to 72) higher likelihood of acidosis compared with those participants in the lowest quartile. There was a significant interaction by age of the association of net endogenous acid production with serum bicarbonate (P=0.005). Among participants 20-39, 40-59, and $60 years old, those participants in the highest net endogenous acid production quartile had 0.26 (95% confidence interval, 20.49 to 20.03), 0.60 (95% confidence interval, 20.92 to 20.29), and 0.49 (95% confidence interval, 20.84 to 20.14) mEq/L lower serum bicarbonate, respectively, compared with participants in the lowest quartile.Conclusion Greater dietary acid is associated with lower serum bicarbonate in the general US population, and the magnitude of this association is greater among middle-aged and elderly persons than younger adults.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 78%

Dietary Acid, Age, and Serum Bicarbonate Levels among Adults in the United States

Amodu

Abramowitz

2013

Clinical Journal of the American Society of Nephrology

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“…With aging, there is a decreased ability of the kidneys to excrete an acid load (14,15). Low bicarbonate levels might reflect occult tubular dysfunction, leading to hydrogen ion retention (16), or an increased acid load that is greater than the aging kidney's ability to excrete the load.…”

Section: Discussionmentioning

confidence: 99%

Association of Serum Bicarbonate with Incident Functional Limitation in Older Adults

Yenchek¹,

Ix²,

Rifkin³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Cross-sectional studies have found that low serum bicarbonate is associated with slower gait speed. Whether bicarbonate levels independently predict the development of functional limitation has not been previously studied. Whether bicarbonate was associated with incident persistent lower extremity functional limitation and whether the relationship differed in individuals with and without CKD were assessed in participants in the Health, Aging, and Body Composition study, a prospective study of well functioning older individuals Design, setting, participants, & measurements Functional limitation was defined as difficulty in walking 0.25 miles or up 10 stairs on two consecutive reports 6 months apart in the same activity (stairs or walking). Kidney function was measured using eGFR by the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and CKD was defined as an eGFR,60 ml/min per 1.73 m 2 . Serum bicarbonate was measured using arterialized venous blood gas. Cox proportional hazards analysis was used to assess the association of bicarbonate (,23, 23-25.9, and $26 mEq/L) with functional limitation. Mixed model linear regression was performed to assess the association of serum bicarbonate on change in gait speed over time.Results Of 1544 participants, 412 participants developed incident persistent functional limitation events over a median 4.4 years (interquartile range, 3.1 to 4.5). Compared with $26 mEq/L, lower serum bicarbonate was associated with functional limitation. After adjustment for demographics, CKD, diabetes, body mass index, smoking, diuretic use, and gait speed, lower serum bicarbonate was significantly associated with functional limitation (hazard ratio, 1.35; 95% confidence interval, 1.08 to 1.68 and hazard ratio, 1.58; 95% confidence interval, 1.12 to 2

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“…85 These authors more recently described the additional exacerbating effects caused by diets high in sodium chloride and agerelated declines in acid excretory capacity. 86,87 To our knowledge, there have been no attempts to test alkali therapy for its effects on bone in patients with CKD before ESRD.…”

Section: Bone Effectsmentioning

confidence: 99%

Current Status of Bicarbonate in CKD

Dobre

Rahman

Hostetter

2015

Journal of the American Society of Nephrology

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Metabolic acidosis was one of the earliest complications to be recognized and explained pathologically in patients with CKD. Despite the accumulated evidence of deleterious effects of acidosis, treatment of acidosis has been tested very little, especially with respect to standard clinical outcomes. On the basis of fundamental research and small alkali supplementation trials, correcting metabolic acidosis has a strikingly broad array of potential benefits. This review summarizes the published evidence on the association between serum bicarbonate and clinical outcomes. We discuss the role of alkali supplementation in CKD as it relates to retarding kidney disease progression, improving metabolic and musculoskeletal complications.

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Renal Net Acid Excretion Capacity Is Comparable in Prepubescence, Adolescence, and Young Adulthood but Falls with Aging

Abstract: The capacity to excrete net endogenous acid does not vary markedly from childhood to young adulthood but falls significantly with age, implying that elderly people may require higher daily alkalizing mineral intake to compensate for renal function losses.

Cited by 45 publications

References 35 publications

Dietary Acid, Age, and Serum Bicarbonate Levels among Adults in the United States

Dietary Acid, Age, and Serum Bicarbonate Levels among Adults in the United States

Association of Serum Bicarbonate with Incident Functional Limitation in Older Adults

Current Status of Bicarbonate in CKD

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